Ask D'Mine: Occult Weight Boosters

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Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1 and diabetes author Wil Dubois, who also works as an educator in a diabetes clinic in his home state of New Mexico.

This week, Wil explores that always-tough issue of weight gain when it comes to diabetes and how food isn't always the culprit.

Pam, type 2 from Montana, writes:I'm on pills and insulin and gaining weight. I've seen every doctor and dietician, and none can explain my weight gain. I'm a healthy eater. Please help me!

Wil@Ask D'Mine answers: Well, crap. I'm not smarter than every doctor and dietitian out there, so I don't know if I'll be able to help either. But I want to try.

First off, kudos to you. Kudos for eating healthy. And kudos for trying to get professional help from doctors and dieticians. So you are doing everything right, but still nothing is working right. Bummer. Well, let's review the various things that can cause weight gain beyond eating 14 tacos for lunch, and maybe we'll stumble onto something everyone else missed.

1. We can't ignore health conditions.

There aren't a whole hell of a lot of them, but there are a few illnesses, diseases, and medical conditions that can really pack the pounds on you. Most of them are major, which, to me, means it's unlikely a doctor (much less several) would miss them. But it's possible. Sometimes when docs focus too much on the forest, they miss the trees. So here we go...

Both kidney failure and congestive heart failure cause weight gain, largely through fluid retention. In a similar fashion the ascites seen in advanced liver failure can pack on pounds from excessive fluid in the abdomen.

One would hope that even a wet-behind-the-ears provider fresh out of school would recognize one of those three... But less-easy to recognize might be the progressive weight gain that's the most common symptom of Cushing's Syndrome, a condition leading to excess cortisol production. One of cortisol's "jobs" in the body is to build and replenish stores of fat, so too much cortisol causes excessive weight gain. The weight gain from Cushing's has a unique signature in that you pack on the pounds in the abdomen, trunk, neck and face—while the limbs remain "normal," or even thin.

A similar pattern of weight distribution is also seen in HIV/AIDS cases. In this case, the virus triggers abnormal fat growth called lipodystrophy in the visceral areas around the internal organs, while wasting away the subcutaneous fat on the limbs.

In a less grim prognosis, a simple under-performing thyroid can lead to weight gain through several mechanisms that lead to a metabolic derangement that causes weight gain even when eating a very low calorie diet. Low thyroid can cause weight gain in either sex, but women are particularly susceptible to it.

Speaking of women, we also need to consider a few weight-gain medical conditions that are unique to the fairer sex, as you are a lady. Menopause is associated with weight gain in many women because of the hormonal shifts seen with this life change. It's also a hormone imbalance that leads to the weight gain commonly seen in Polycystic Ovary Syndrome. Oh. Right. And the number-one leading cause of weight gain in women is pregnancy. No kidding.

Of course there are other things in life, some surprising, that lead to weight gain.

2. Now, on to those conditions that come with life...

For many years the the white coats believed that the weight gain seen in people suffering from chronic stress was due to "stress eating." And in some people, that's part of the story. After all, Hostess Cupcakes have been used to medicate stress by several generations of Americans. But there's more to the story than that. It turns out that chronic stress triggers an inflammatory response that releases our old friend cortisol (the key player in Cushing's weight gain).

Sleep deprivation is also associated with weight gain. And while part of the weight gain could be from eating to stay awake during the day, like with the stressed-out, the sleep deprived are also suffering from hormonal issues. In this case it's not cortisol, but the twin brain hormones of ghrelin and leptin that control appetite, satiety, and energy balance.

And if stress and sleep deprivation weren't depressing enough, there's depression, too. Weight gain and depression are closely linked, but the smoking gun behind the connection is hotly debated. Some experts feel that it's simply a matter of the depressed not caring what they eat, while others suspect that those tricky hormones may be up to no good again. I'm betting that, as with stress, it's a bit of both.

3. What's inside your medicine cabinet?

Lastly, one unexpected culprit in mystery weight gain might not be your body or your environment, but your bathroom instead. Yep, I'm talking about your medicine cabinet. A wide number of prescription drugs that cross a whole gambit of medical conditions can cause weight gain. The pathophysiology behind the increase in weight is a mystery in most cases, but the results on the bathroom scale speak for themselves.

When it comes to meds, however, there's an amazing variation in how any one med will affect any one person. So keep that in mind. Just because you take one of the following meds doesn't mean that it will make you fat. It just means it will make some people fat.

Now, there's no way to include all of the meds that cause weight gain in some folks in our limited space here, but these are the top suspects:

Brain meds. Anti-psychotics are notorious for causing HUGE weight gain. Oh, and HUGE blood sugar spikes, too. But, hey, this may be the lesser of evils. Being psychotic can be dangerous to your health (and the health of others, too). But less well known is the fact that many garden-variety anti-depressants also are associated with weight gain, as are many migraine meds.

Heart meds. Both beta-blockers and calcium channel blockers are associated with weight gain. Of course, on the flip side, fatal heart attacks are associated with excessive weight loss, so you need to keep perspective. The good news here is that if your blood-pressure meds are causing weight gain for you, there are alternatives.

Allergy meds. Yep, the humble antihistamine can cause weight gain.

And the list goes on and on. Steroids can cause weight gain. Some birth control pills cause weight gain. Some diabetes meds can cause weight gain, especially the TZDs and the sulfonylurea class.

What about insulin? Does insulin cause weight gain? Some people swear it does, but I don't believe it myself. OK, well, many people gain weight when insulin is started, but I don't think the insulin is to blame. In fact, I believe the blame falls on the fact that in our country we generally hold off starting insulin until the last minute. Insulin is often started in type 2's when all else fails, which means that insulin is typically started in a state of hyperglycemia.

That's an important point to consider, because when your blood sugar is high, your body will dump sugar into the urine. With that sugar goes calories. Hyperglycemia is a diet of sorts; if you are peeing calories away, you can eat more than your basal metabolic rate and not gain weight. At least until someone like me comes along and starts insulin. Then the calories that were going down the toilet now go to the waist. Or the thighs.

When we start someone on insulin at our clinic, we always look at diet at the same time, and discuss this phenomenon with the patients. I've been involved in something like 300 insulin "starts" over the last decade, and only a handful of people gained weight. And those were the ones that continued to eat 14 tacos for lunch.

The overall rundown, IMHO (hey, you asked!):

So there's more to weight gain than food. Things can go wrong in your body to tip the delicate balance of the hormones charged with storing fat and burning fuel. Sometimes disease is to blame. Sometimes environment. Sometimes the medications you take to solve other problems.

It can be hard to ferret out the cause, but there is a cause. I don't believe in the unexplained.Something is causing your weight gain. Get a physical with standard lab tests. Look to your life and environment, then look through your medicine cabinet.

The answer is waiting for you to find it.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more
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Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community.
The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines.
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